The document discusses strategies for aligning providers with payers through business partnerships, shared savings programs, and loyalty programs. It recommends establishing mutual goals and accountability, clearly communicating policies and performance measures, and rewarding providers for meeting clinical and administrative targets. Loyalty programs should build long-term relationships through referrals, co-marketing, education, and regular communication using various channels.

1. Provider Alignment & Loyalty Programs Providers as Business Partners

2. Business Partner Imperatives Ensure a stable healthcare delivery platform Finding common goals Establish accountability Communicate clearly and often Measure performance Reward performance

3. Provider Alignment Strategies Mutual interest for all stakeholders (provider, payer, member/customer) Requires contract terms and conditions that are explicit Program policies must be reasonable and transparent Pay for performance standards with clear cut goals and outcome measures

4. Pay for Performance Methods Clinical Measures HEDIS/NCQA Specialty treatment protocols AHRQ Community Quality Measurement Administrative Measures Contract compliance Member satisfaction Claims submission

5. Shared Savings Programs CMS approach (“accountable care organization”) Savings as determined by per capita cost of assigned membership vs budget Commercial payer approach Similar but adjusted for plan design and network features Medicaid approach More specific to HEDIS (e.g. Pennsylvania Medicaid model All approaches require understanding and buy-in

6. Provider Loyalty Programs Establish brand recognition among competitors Build long term relationships Foster health plan membership through referrals

7. Provider Loyalty Programs Continued Opportunities for business exchange: Advisory councils for ideas and feedback Co-marketing of programs and services to other clients Co-sponsor consumer health education and improvement programs Continuing education programs In-kind consulting services

8. Provider Loyalty Programs Continued Communication Strategies Dedicated professional services agents Web page portal Program policies Provider newsletter Other health care information links “ Fax Blast” Important program notices Education events

9. Contact Us Eagle Run Managed Care, LLC http://www.eaglerunmcc.com 937-350-5457 25 years managed care experience